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141. Covid-19: Guidance on adaptations to standard UK critical care medication prescribing and administration practices during pandemic emergency pressures

sparing agents. However, beware that these are less titratable. Antibiotics ? Consider not commencing antibiotics empirically at presentation. ? Continue to follow local antimicrobial policies unless specific shortages occur. ? Continue to practice good antimicrobial stewardship with regular review to stop, de- escalate or switch to oral/ enteral route. Stress ulcer prophylaxis ? If standard practice is intravenous ranitidine consider switching to PPI if unavailable or stopping once enteral feed (...) . ? Consider the local implementation of teams to administer IV medicines (e.g. roles for doctors who are re-deployed from other clinical areas). ? Consider bolus dosing / administration of medicines where possible (e.g. magnesium, certain antibiotics). ? Administration (i.e. if a person in PPE already, doctor or nurse, to check which other professional group role needs to be done in any given timeline). 2 Alternative techniques First line drugs / priority clinical indications Alternative drugs Sedation

2020 ICM Anaesthesia COVID-19

142. Clinical management of severe acute respiratory infection when COVID-19 is suspected

assessment for patients with sepsis. Remark 1: Although the patient may be suspected to have COVID-19, administer appropriate empiric antimicrobials within 1 hour of identification of sepsis (5). Empiric antibiotic treatment should be based on the clinical diagnosis (community- acquired pneumonia, health care-associated pneumonia [if infection was acquired in health care setting] or sepsis), local epidemiology and susceptibility data, and national treatment guidelines. Remark 2: When there is ongoing (...) - detail/laboratory-testing-for-2019-novel-coronavirus-in-suspected-human-cases-20200117). Additionally, guidance on related biosafety procedures is available (https://apps.who.int/iris/bitstream/handle/10665/331138/WHO-WPE-GIH-2020.1-eng.pdf). Collect blood cultures for bacteria that cause pneumonia and sepsis, ideally before antimicrobial therapy. DO NOT delay antimicrobial therapy to collect blood cultures. Collect specimens from the upper respiratory tract (URT; nasopharyngeal and oropharyngeal

2020 WHO Coronavirus disease (COVID-19) Pandemic

143. Management of patients with severe to critical COVID-19

antibacterial agents, over no antibacterials. If the treating team initiates empiric antibacterials, they should assess for de-escalation daily, and re-evaluate the duration of therapy and spectrum of coverage based on the microbiology results and the patient’s clinical status. [Adapted from SSC] 33.36 For mechanically ventilated adults with COVID-19 and moderate to severe ARDS: We suggest using, as needed, intermittent boluses of neuromuscular blocking agents (NMBA), over continuous NMBA infusion

2020 National COVID-19 Clinical Evidence Taskforce

144. Care of patients with liver disease during the COVID-19 pandemic: EASL-ESCMID position paper

injury with jaundice seem to be rare 39 Patients with decompensated cirrhosis should not be treated Consider risk of HBV reactivation 40 Methylprednisolone (steroids) Corticosteroids bind nuclear receptors to dampen proin?ammatory cytokines Mostly used in patients with septic shock Currently NOT recommended by WHO 41 The risk of other infections (e.g. SBP) and viral shedding may increase in patents with decompensated liver cirrhosis Consider antimicrobial prophylaxis Consider risk of HBV

2020 European Association for the Study of the Liver

145. Updated SOGC Committee Opinion – COVID-19 in Pregnancy

and discontinuation of precautions should be determined in accordance with Public Health Agency of Canada guidelines,(15) and provincial and territorial guidance. • Health care providers can consider empiric antibiotic therapy for superimposed bacterial pneumonia in women with confirmed COVID-19 infection or severe respiratory disease. First-line antibiotics are oral amoxicillin for stable patients and ceftriaxone for severe disease, based on general recommendations for the management of pneumonia. • For maternal

2020 Society of Obstetricians and Gynaecologists of Canada

146. COVID-19 - paediatric scenarios

. Following transfer, the room should be chlorine cleaned. Special cases: children with febrile neutropenia and suspected COVID-19 Children should initially be assessed and tested in ED not the wards. Prompt administration of broad-spectrum antibiotics for the management of febrile neutropenia is essential. In the Oncology wards may wish to designate specific cubicles for patients with suspected COVID-19. All infectious disease precautions must be followed as for other COVID-19 patients as well

2020 Royal College of Paediatrics and Child Health

147. COVID-19 - guidance for acute settings

for the . It outlines key principles for the medical management of children admitted to hospital with COVID-19, including: Radiology Fluids Antipyretics Respiratory support Antibiotics Antivirals Bronchodilators and treatment of children with asthma attacks Systemic steroids Liver dysfunction Hydroxychloroquine This guidance is based on literature review of published and unpublished data, expert opinion, and national/international guidelines, and is subject to updates as evidence becomes available. Discharging

2020 Royal College of Paediatrics and Child Health

148. COVID-19 - guidance for paediatric services

protective equipment should be worn, irrespective of whether the child has symptoms consistent with COVID-19 or not. Suspected tonsillitis in primary care or emergency departments During the COVID-19 pandemic, if a diagnosis of tonsillitis is suspected based on clinical history, the default becomes not examining the throat unless absolutely necessary. If using the to decide if antibiotics are indicated (validated in children 3 years and older), we suggest that a pragmatic approach is adopted (...) , and automatically starting with a score of 2 in lieu of an examination seems reasonable. Antibiotics should be considered in children with a total feverpain score of 4 or 5 (we suggest children with a score of 3 or less receive alone). Although this is likely to result in a temporary increase in antibiotic prescribing in children, we feel that this is preferable to healthcare staff being unnecessary exposed to COVID-19. Antibiotics rarely confer a benefit in children under 3 years with tonsillitis and should

2020 Royal College of Paediatrics and Child Health

149. Chronic obstructive pulmonary disease (COPD)

Workshops 5 Pharmacologic Treatment 6 Bronchodilator therapy 6 Medication guide 7 Oxygen therapy 7 Treatments that are not recommended 8 COPD Exacerbations 9 Treatment of COPD exacerbations 10 Prophylactic antibiotics for exacerbation prevention 11 Follow-up and Monitoring 12 Medication monitoring 12 Long-term steroid use and osteoporosis risk 12 Immunizations 12 Referral 13 Evidence Summary 14 References 16 Guideline Development Process and Team 18 Appendix 1. COPD Assessment Test (CAT). 19 Appendix 2 (...) symptom (increased dyspnea or increased sputum volume) is required for an exacerbation diagnosis. A chest X-ray is recommended for all patients with a suspected COPD exacerbation. Severity of exacerbation ? Mild exacerbation: the person has an increased need for short acting bronchodilators, which they can manage in their own normal environment. ? Moderate exacerbation: the person has a sustained worsening of respiratory status that requires treatment with systemic corticosteroids and/or antibiotics

2020 Kaiser Permanente Clinical Guidelines

150. COVID-19 - guidance for neonatal settings

. The family should be advised to self isolate with the baby for 14 days from birth. Term or late preterm baby requiring additional care Well babies born to suspected/confirmed COVID-19 mothers and who require additional care (eg intravenous antibiotics) should be assessed in the labour ward and a decision made as to whether additional care can safely be provided at the mother’s bedside. Avoid NNU admission if possible and safe. Babies requiring admission to the NNU should be assessed in a designated area

2020 Royal College of Paediatrics and Child Health

151. Beta-lactam allergy in the paediatric population

Beta-lactam allergy in the paediatric population Beta-lactam allergy is commonly diagnosed in paediatric patients, but over 90% of individuals reporting this allergy are able to tolerate the medications prescribed after evaluation by an allergist. Beta-lactam allergy labels are associated with negative clinical and administrative outcomes, including use of less desirable alternative antibiotics, longer hospitalizations, increasing antibiotic-resistant infections, and greater medical costs. Also (...) , children with true IgE-mediated allergy to penicillin medications are often advised to avoid all beta-lactam antibiotics, including cephalosporins, which is likely unnecessary in greater than 97% of those reporting penicillin allergies. Most patients can be safely treated with penicillin or amoxicillin if they do not have a history compatible with IgE-mediated or systemic, delayed reactions such as Stevens-Johnson syndrome (SJS), serum sickness-like reactions, drug reaction with eosinophilia

2020 Canadian Paediatric Society

153. Clinical guide for the management of respiratory patients during the coronavirus pandemic

physicians have support and training in helping deliver some routine respiratory care. This could be facilitated by deploying hospital-based nurses to support colleagues. Ambulatory care and management of pleural disease • Maximise ambulatory care options to allow safe discharge from A&E/MAU of appropriate cases • Use home intravenous antibiotic services where available • Move to a day case, ambulatory care model for pleural disease • Agree local pathways for pleural disease that can be used for urgent (...) admission avoidance • There should be a clean day case area for patients to attend for pleural procedures, administration of biologics for asthma, insertion of lines and test dose of antibiotics for CF 3 | Clinical guide for the management of respiratory patients during the coronavirus pandemic Outpatient clinics GIRFT has produced a virtual working guide as part of this series of Specialty guides: www.england.nhs.uk/coronavirus/secondary-care/other-resources/specialty-guides/ • The majority

2020 Covid-19 Ad hoc guidelines

154. Information for adult patients with immune thrombocytopenia in the setting of COVID-19 pandemic

Cyclosporine Vincristine Rituximab (given in the past 12 months) Splenectomy (patients are advised to be diligent with their antibiotic prophylaxis and be up- to-date with their vaccination schedule) Neither Romiplostim (N-Plate) nor Eltrombopag (Revolade) will affect the immune system and risk will depend on other treatments being received at the same time or in the recent past. Any change in ITP medication should be discussed with your ITP centre and should NOT be discontinued unless advised. If you

2020 Covid-19 Ad hoc guidelines

155. Haemoglobinopathy HCCs response to Covid-19

. If they present out of hours the patient or the admitting medical/haematology teams should be encouraged to contact the haemoglobinopathy teams. If self-isolating they should be given additional antibiotics, phone follow up should be arranged and they should be asked to present if they have worsening symptoms. Red flag symptoms: Patients should be encouraged to attend the Emergency Department (A+E) or call 999 if any of the following occur: ? Uncontrolled pain >7/10 despite usual home analgesia ? Respiratory

2020 Covid-19 Ad hoc guidelines

157. Recommendations for good practice in Ultrasound: Oocyte retrieval Full Text available with Trip Pro

and training. One of the major research gaps was training and competence. This paper has also outlined a list of research priorities (including clarification on the value or full blood count, antibiotic prophylaxis and flushing, and the need for training and proficiency). LIMITATIONS, REASONS FOR CAUTION The recommendations of this paper were mostly based on clinical expertise, as at present, only a few clinical trials have focused on the oocyte retrieval techniques, and almost all available data (...) practice in US-guided oocyte retrieval. The Delphi method survey included 53 questions completed in three rounds and resulted in 32 standards of practice. In addition to the results of the dissertation, a new literature search was conducted. Databases (PUBMED/Medline and the Cochrane Library) were searched from inception to 17 July 2018. Search terms focussed on US, oocyte retrieval/pick up, Doppler, sedation, anaesthesia, infection, antibiotics, hydrosalpinx and flushing, and included extended key

2020 European Society of Human Reproduction and Embryology

158. Paediatric inflammatory multisystem syndrome and SARS-CoV-2 infection in children

countries and the UK in this decreasing phase of the epidemic. It is possible that more cases will be recognised as more countries enter this phase and more publicity is given to this syndrome. Clinical management Based on information from the reporting countries, management of PIMS-TS cases has been mostly supportive as they are at the severe end of the spectrum. As KD was part of the differential diagnosis, treatment with IVIG has been the predominant management option. Antibiotics, corticosteroids

2020 ICM Anaesthesia COVID-19

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